In performing gynecological endoscopic examinations or surgical procedures, it is desirable to dilate the vaginal orifice in order to examine or operate on structures within the vaginal cavity such as the cervix. In order to make such examinations, or perform such surgical procedures, a duck-billed speculum is conventionally employed.
The conventional duck-billed speculum comprises two members; an upper member having a downward facing duck-billed portion connected to a handle portion at an obtuse angle, and a lower member having an upward facing duck-billed portion connected to a handle portion at an acute angle. The two members are pivotally attached to each other at the points of angulation such that the duck-billed portions separate from each other when the handle portions are urged toward each other. The handle portion of the upper member has an opening which establishes a line of sight into the space formed by the opposing duck-billed portions of the upper and lower members. In some cases, conventional duck-billed specula are provided with a locking mechanism to lock the duck-billed portions in desired positions of separation for the duration of the examination or surgical procedure.
Such conventional duck-billed specula may also be provided with a vacuum tube, built into the duck-bill portion of the upper member, which may be connected to a vacuum apparatus for evacuating the vaginal cavity, by suction, of gases or vapors during medical proceedings. In certain types of surgical procedures, such as those using laser or leep technology, the Occupational Safety and Health Act requires the use of vacuum tubes because the resulting gases or vapors can be toxic.
These conventional duck-bill specula are used by inserting the duck-billed portion through the vaginal orifice in a closed position. Once inserted, the user may urge the handle portions toward each other to dilate the vaginal orifice as desired. The vaginal cavity is then exposed and the user may perform desired medical procedures through the opening in the handle portion of the upper member. An example of a conventional duck-billed speculum apparatus is disclosed in U.S. Pat. No. 4,206,750 which issued on Jun. 10, 1980 to Kaivola.
The disadvantages inherent in the conventional duck-billed specula are several. Because the duck-bills must be urged apart in order to dilate the vaginal orifice, body tissue is not only exposed on each side of the duck-bills, but may also protrude into the resulting gap between the duck-bills. This results in two disadvantages. First, during surgical procedures involving laser, leep, scalpels, or other surgical cutting apparatus, the surrounding body passage tissue is subject to being accidentally cut or burned. Secondly, tissue protruding into the gap between the duck-bills is subject to being pinched within the duck-bill mechanism. Such pinching will not only cause the patient pain or injury, it may also cause the patient to tense up, thereby interfering with the medical procedure being performed.
Another disadvantage is that due to the mechanical and configuration requirements of duck-billed specula, and the protrusion of surrounding tissue into the gap formed between the duck-bills, the viewing aperture formed between the duck-bills when dilated is relatively small. Likewise, the work space between the duck-bills is also relatively small. As a result, the line of sight and space provided for examinations and surgical procedures is limited.
Yet another disadvantage is the fact that conventional duck-billed specula employ a mechanical hinge which is not only subject to breakage, especially in the case of plastic specula, but is also more expensive to manufacture and assemble. Furthermore, the mechanical hinge is disadvantageous because it can pinch or catch the flesh or hair of the patient.
Another type of conventional speculum comprises a cylindrical tube having an outwardly tapering user end such as the one sold by Graham-Field and illustrated in FIG. 7. The disadvantages inherent in this design are as follows.
First, there is nothing to prevent such a speculum from sliding out of the vaginal cavity in which it is being used. Instead, the user must hold this speculum in place or continually push it back into position. Second, there is no provision for a vacuum tube connection. An operator using such a speculum must insert and support a vacuum tube through the limited cylindrical opening available. Third, the cylindrical configuration of this speculum limits the space available at the user end for performing medical procedures.
Accordingly, there remains a need for a simple gynecological speculum which offers the medical user the maximum aperture available in which to examine and operate on a patient, which is retained within the vaginal cavity into which it has been inserted, and which also provides for evacuation of the vaginal cavity by suction during medical proceedings.